Eligibility Specialist

McGregor Foundation•Warrensville Heights, OH

6d•Onsite

About The Position

McGregor PACE (Program of All-Inclusive Care for the Elderly) is a community service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing seniors to remain at home. We are looking for an Eligibility Specialist who handles Medicaid renewals for McGregor PACE participants, maintains accurate enrollment, updates participant status in the Electronic Medical Record (EMR), and manages collections for participant balances.

Requirements

Current Ohio driver’s license and reliable transportation (required).
Proficiency in Windows, Word, Excel, and PowerPoint (required).
Strong communication skills (required).

Nice To Haves

One-year experience in Medicaid waiver programs and health/social services (preferred).
Experience working with older adults, especially those with dementia (preferred).
Knowledge of Ohio Medicaid and Federal Medicare regulations/systems (preferred).

Responsibilities

Conduct appointments to obtain authorizations and paperwork for Medicaid renewals.
Respond to participant questions about Medicaid status and benefits.
Act as Medicaid Authorized Representative for all McGregor participants.
Follow up on application/renewal processes with SMBC (Specialized Medicaid Benefits Center) and other organizations.
Communicate with the Eligibility Manager and/or Team Lead about any delays affecting eligibility.
Document all activities in the EMR and on the Medicaid Renewal Tracking log during the Medicaid application and renewal processes.
Serve as a resource for participants, families, and PACE staff regarding Medicaid eligibility.
Monitor Accounts Receivable (AR) aging, make collection calls, and set up payment plans.
Prepare required CMS reporting and communications.
Update PACE EMR enrollments/disenrollments and other software systems.
Send out PACE participant medical ID cards.
Process Records Force digital mail deliveries.
Update and issue participant subsidy letters for group home and assisted living.
Complete other duties as assigned.